In selective patients, chyme reinfusion via distal loop ileostomy reduced anastomotic leakage rate after excision of colonic fistula following severe acute pancreatitis

Abstract

Abstract Purpose This study aimed to investigate effect of chyme reinfusion (CR) via distal loop ileostomy, in selective patients with pancreatitis cure, on the reduction of anastomotic leakage rate after excision of colonic fistula following severe acute pancreatitis (SAP) Methods From January 2009 to May 2021, patients who were suitable for CR via distal loop ileostomy and underwent excision of colonic fistula following SAP were considered to be eligible. Patients were selected and considered suitable for CR if the following conditions were met: (1) SAP cured; (2) no colon obstruction; (3) colonic fistula drainage tube was in place; and (4) no pus cavity was around the fistula and the sinus mature. Before 2014, CR was not used, whereas it was widely used after 2014 in selected patients. Patients were divided into the CR group and non-CR group according to whether CR was performed. The effect of CR on reduction of postoperative anastomotic leakage were then investigated. Results Eighty-five patients were enrolled in the study. There were 40 patients in the non-CR group and 45 patients in the CR group, with a total of 28 (32.9%) patients with anastomotic leakage. CR (OR = 0.48; 95% CI: 0.24–0.95; p = 0.036) reduced the incidence of anastomotic leakage. In addition, CR (HR = 0.51; 95% CI: 0.27–0.86, p = 0.012) was shown to reduce the incidence of postoperative ileus. Conclusion In selected patients with pancreatitis cure, CR via distal loop ileostomy for colonic fistula following SAP reduced the anastomotic leakage rate.